Posted December 05, 2023 in Breast
The “internal bra” procedure involves placement of an artificial mesh to support breast implants. This is sometimes used for primary (first-time) breast augmentation and very frequently used in secondary (revision) augmentation.
Why use mesh to support breast implants for a first-time breast augmentation surgery?
Many surgeons place silicone gel or saline breast implants through a subglandular (above muscle) or, more popularly, a dual plane approach (lower half above muscle, upper half below). This means that either the entire implant or the entire lower half of the implant has no support from the pectoralis major muscles. Without muscular support, the implants frequently drop excessively, which is called “bottoming out.” This causes loss of upper breast volume and excessive lower breast volume. Some women also develop “double bubbles,” which entails not one but two separate creases beneath each breast.
In an effort to prevent bottoming out, many surgeons now routinely recommend internal mesh, most commonly GalaFLEX, for primary breast enhancement surgery. Having performed thousands of breast enlargements over the past 28 years, I can unequivocally state that this is completely unnecessary in the overwhelming majority of patients. Why?
The pectoralis major muscles are perfectly capable of supporting the vast majority of breast implants. It makes no sense to cut the bottom half of the pec major muscle—only to have to immediately reconstruct it with an artificial mesh. In addition, placement of mesh adds complexity and considerable expense to the surgery, increases the risk of postoperative complications, and doubles the number of foreign bodies from two (implants) to four (implants and mesh).
Unfortunately with the rising popularity of dual plane augmentation (half above and half below muscle), many plastic surgeons seem to have forgotten that if you leave the pec major muscles largely intact, they can hold up breast implants without any help.
Why use mesh to support breast implants for a second-time breast augmentation surgery?
Click here for the answer.